Digitally disconnected: A qualitative study of patient perspectives on the digital divide and potential solutions (Preprint)

2021 ◽  
Author(s):  
Maria Alcocer Alkureishi ◽  
Z-Yi Choo ◽  
Ali Rahman ◽  
Kimberly Ho ◽  
Jonah Benning-Shorb ◽  
...  
Keyword(s):  
Digital Divide ◽  
Low Income ◽  
Medical Center ◽  
Clinical Care ◽  
Healthcare Delivery ◽  
Patient Perspectives ◽  
Valuable Insight ◽  
Theory Approach ◽  
Technology Access ◽  
Broadband Internet

BACKGROUND As telemedicine utilization increased during the COVID-19 pandemic, divergent usage patterns for video and audio-only telephone visits emerged. Older, low-income, minority, and non-English speaking Medicaid patients especially are at highest risk of experiencing technology access and digital literacy barriers. This raises concern for disparities in healthcare access and widening of the “digital divide”, the separation of those with technological access and knowledge and those who do not. While studies demonstrate correlation between racial and socioeconomic demographics and technological access and ability, individual patients' perspectives of the divide and its impacts remain unclear. OBJECTIVE We aimed to interview patients to understand their perspectives on 1) the definition, causes, and impact of the digital divide, 2) whose responsibility it is to address, and 3) potential solutions to mitigate the digital divide. METHODS Between December 2020-March 2021, we conducted 54 semi-structured telephone interviews with adult patients and parents of pediatric patients who had virtual visits (phone and/or video) sometime between March and September 2020 at the University of Chicago Medical Center primary care clinics. A grounded theory approach was used to analyze interview data. RESULTS Patients were keenly aware of the digital divide and described impacts beyond healthcare, including employment, education, community and social contexts, and personal economic stability. Patients described that individuals, government, libraries, schools, healthcare organizations, and even private businesses all shared the responsibility to address the divide. Proposed solutions to address the divide included conducting community technology needs assessments and improving technology access, literacy training, and resource awareness. Recognizing that some individuals will never cross the divide, patients also emphasized continued support of low-tech communication methods and healthcare delivery to prevent widening of the digital divide. Furthermore, patients viewed technology access and literacy as drivers of the social determinants of health (SDOH), profoundly influencing how SDOHs function to worsen or improve health disparities. CONCLUSIONS Patient perspectives provide valuable insight into the digital divide and can inform solutions to mitigate health and resulting societal inequities. Future work is needed to understand the digital needs of disconnected individuals and communities. As clinical care and delivery continue to integrate telehealth, studies are needed to explore whether having a video or audio-only phone visit results in different patient outcomes and utilization. Advocacy efforts to disseminate public and private resources can also expand device and broadband internet access, improve technology literacy, and increase funding to support both high- and low-tech forms of healthcare delivery for the disconnected.

scholarly journals Family Conditions and the Accessibility of Online Education: The Digital Divide and Mediating Factors

2021 ◽  
Vol 13 (15) ◽  
pp. 8590
Author(s):  
Jiafeng Gu
Keyword(s):  
Online Education ◽  
Digital Divide ◽  
Low Income ◽  
Rural Areas ◽  
Urban Areas ◽  
Internet Access ◽  
Broadband Internet ◽  
Low Income Families ◽  
The Impact ◽  
At Home

This study is an exploration of the digital divide between urban and rural areas, and it was conducted to assess the impact of the minimum living guarantee system on online education in China. The results of the research showed that 83.38% of students in low-income families have been able to participate in online education at home during the pandemic, while 16.62% of students in low-income families have been unable to do so. The absence of computers, smartphones, and broadband Internet access in low-income households reduces the likelihood of children being able to participate in online education at home. In terms of accessing online education at home, students from urban areas have obvious advantages over those from rural ones, and students from minimum living guarantee families have obvious advantages over those from marginal minimum living guarantee ones. This study also showed that the presence of online education-related amenities, including computers, smartphones, and Internet access, mediates the relationship between the subsistence allowance system, Hukou, and accessibility of online education. To address this issue, this paper includes suggestions for bridging the digital divide in online education.

scholarly journals Ethical considerations in global surgery: a scoping review

2020 ◽  
Vol 5 (4) ◽  
pp. e002319 ◽  
Author(s):  
Chantalle Lauren Grant ◽  
Tessa Robinson ◽  
Alreem Al Hinai ◽  
Cheryl Mack ◽  
Regan Guilfoyle ◽  
...  
Keyword(s):  
Scoping Review ◽  
Low Income ◽  
Current Knowledge ◽  
Clinical Care ◽  
Monitoring And Evaluation ◽  
Global Surgery ◽  
Original Research ◽  
Theory Approach ◽  
Ethical Challenges ◽  
Ethical Considerations

IntroductionAn unmet burden of surgical disease exists worldwide and is disproportionately shouldered by low-income and middle-income countries (LMICs). As the field of global surgery grows to meet this need, ethical considerations need to be addressed. Currently, there are no formal guidelines to help inform relevant stakeholders of the ethical challenges and considerations facing global surgical collaborations. The aim of this scoping review is to synthesise the existing literature on ethics in global surgery and identify gaps in the current knowledge.MethodsA scoping review of relevant databases to identify the literature pertaining to ethics in global surgery was performed. Eligible articles addressed at least one ethical consideration in global surgery. A grounded theory approach to content analysis was used to identify themes in the included literature and guide the identification of gaps in existing literature.ResultsFour major ethical domains were identified in the literature: clinical care and delivery; education and exchange of trainees; research, monitoring and evaluation; and engagement in collaborations and partnerships. The majority of published literature related to issues of clinical care and delivery of the individual patient. Most of the published literature was published exclusively by authors in high-income countries (HICs) (80%), and the majority of articles were in the form of editorials or commentaries (69.1%). Only 12.7% of articles published were original research studies.ConclusionThe literature on ethics in global surgery remains sparse, with most publications coming from HICs, and focusing on clinical care and short-term surgical missions. Given that LMICs are frequently the recipients of global surgical initiatives, the relative absence of literature from their perspective needs to be addressed. Furthermore, there is a need for more literature focusing on the ethics surrounding sustainable collaborations and partnerships.

US digital divide will not be easily bridged

2019 ◽  
Keyword(s):  
Inner City ◽  
Digital Divide ◽  
Low Income ◽  
High Speed ◽  
Internet Access ◽  
Government Support ◽  
Broadband Internet ◽  
Content Type ◽  
Digital Divides ◽  
The Us

Subject The US digital divide over broadband internet access and its implications. Significance A digital divide between those that can use the internet at broadband speeds and those that cannot is persisting. Impacts Government support for digital provision will likely include direct public sector spending and opportunities for private firms. Expanded digital provision will benefit the currently underserved rural and low-income inner-city areas. Those without access to high speed internet will be disadvantaged in terms of education and accessing jobs. Expansion of 5G could exacerbate digital divides: affluent areas may be connected first, absent incentives to do otherwise.

scholarly journals Healthcare Delivery and Huntington’s Disease During the Time of COVID-19

2021 ◽  
pp. 1-10
Author(s):  
Anna C. Pfalzer ◽  
Lisa M. Hale ◽  
Elizabeth Huitz ◽  
Danielle A. Buchanan ◽  
Brittany K. Brown ◽  
...  
Keyword(s):  
Huntington's Disease ◽  
Huntington’S Disease ◽  
Low Income ◽  
Clinical Care ◽  
Healthcare Delivery ◽  
Well Being ◽  
Stress Levels ◽  
Patient Stress ◽  
The Impact ◽  
At Home

Background: Safer-at-home orders during the COVID-19 pandemic altered the structure of clinical care for Huntington’s disease (HD) patients. This shift provided an opportunity to identify limitations in the current healthcare infrastructure and how these may impact the health and well-being of persons with HD. Objective: The study objectives were to assess the feasibility of remote healthcare delivery in HD patients, to identify socioeconomic factors which may explain differences in feasibility and to evaluate the impact of safer-at-home orders on HD patient stress levels. Methods: This observational study of a clinical HD population during the ‘safer-at-home’ orders asked patients or caregivers about their current access to healthcare resources and patient stress levels. A chart review allowed for an assessment of socioeconomic status and characterization of HD severity. Results: Two-hundred and twelve HD patients were contacted with 156 completing the survey. During safer-at-home orders, the majority of HD patients were able to obtain medications and see a physician; however, 25% of patients would not commit to regular telehealth visits, and less than 50% utilized an online healthcare platform. We found that 37% of participants were divorced/single, 39% had less than a high school diploma, and nearly 20% were uninsured or on low-income health insurance. Patient stress levels correlated with disease burden. Conclusion: A significant portion of HD participants were not willing to participate in telehealth services. Potential explanations for these limitations may include socioeconomic barriers and caregiving structure. These observations illustrate areas for clinical care improvement to address healthcare disparities in the HD community.

scholarly journals Risk factors associated with physician trainee concern over missed educational opportunities during the COVID-19 pandemic

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sunny S. Lou ◽  
Charles W. Goss ◽  
Bradley A. Evanoff ◽  
Jennifer G. Duncan ◽  
Thomas Kannampallil
Keyword(s):  
Risk Factors ◽  
Clinical Education ◽  
Medical Center ◽  
Clinical Care ◽  
Academic Medical Center ◽  
Clinical Work ◽  
Educational Opportunities ◽  
Missed Opportunities ◽  
Physician Trainee ◽  
At Home

Abstract Background The COVID-19 pandemic resulted in a transformation of clinical care practices to protect both patients and providers. These changes led to a decrease in patient volume, impacting physician trainee education due to lost clinical and didactic opportunities. We measured the prevalence of trainee concern over missed educational opportunities and investigated the risk factors leading to such concerns. Methods All residents and fellows at a large academic medical center were invited to participate in a web-based survey in May of 2020. Participants responded to questions regarding demographic characteristics, specialty, primary assigned responsibility during the previous 2 weeks (clinical, education, or research), perceived concern over missed educational opportunities, and burnout. Multivariable logistic regression was used to assess the relationship between missed educational opportunities and the measured variables. Results 22% (301 of 1375) of the trainees completed the survey. 47% of the participants were concerned about missed educational opportunities. Trainees assigned to education at home had 2.85 [95%CI 1.33–6.45] greater odds of being concerned over missed educational opportunities as compared with trainees performing clinical work. Trainees performing research were not similarly affected [aOR = 0.96, 95%CI (0.47–1.93)]. Trainees in pathology or radiology had 2.51 [95%CI 1.16–5.68] greater odds of concern for missed educational opportunities as compared with medicine. Trainees with greater concern over missed opportunities were more likely to be experiencing burnout (p = 0.038). Conclusions Trainees in radiology or pathology and those assigned to education at home were more likely to be concerned about their missed educational opportunities. Residency programs should consider providing trainees with research or at home clinical opportunities as an alternative to self-study should future need for reduced clinical hours arise.

scholarly journals COVID-19 Pandemic and Telehealth: allergy patient perspectives in an urban, academic medical center

2021 ◽  
Vol 147 (2) ◽  
pp. AB168
Author(s):  
Darshil Patel ◽  
Andrea Pappalardo ◽  
Vanessa Harmon ◽  
Mary Pasquinelli ◽  
Julia Trosman ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Patient Perspectives ◽  
Academic Medical

scholarly journals Scoping review protocol: bladder cancer in Nigeria: what are the gaps in clinical care and research?

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e041894
Author(s):  
Joyce Kibaru ◽  
Pinky Kotecha ◽  
Abdulkarim Muhammad Iya ◽  
Beth Russell ◽  
Muzzammil Abdullahi ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Scoping Review ◽  
Low Income ◽  
Clinical Care ◽  
Grey Literature ◽  
Case Series ◽  
Cochrane Library ◽  
Future Research ◽  
Scoping Reviews ◽  
Local Risk

IntroductionBladder cancer (BC) is the 10th common cancer worldwide and ranks seventh in Nigeria. This scoping review aims to identify the gaps in clinical care and research of BC in Nigeria as part of the development of a larger national research programme aiming to improve outcomes and care of BC.Methods and analysisThis review will be conducted according to Arksey and O’Malley scoping review methodology framework. The following electronic databases will be searched: Medline (using the PubMed interface), Ovid Gateway (Embase and Ovid), Cochrane library and Open Grey literature. Two independent reviewers will screen titles and abstracts and subsequently screen full-text studies for inclusion, any lack of consensus will be discussed with a third reviewer. Any study providing insight into the epidemiology or treatment pathway of BC (RCTs, observations, case series, policy paper) will be included. A data chart will be used to extract relevant data from the included studies. Results will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. A consultation process will be carried out with a multidisciplinary team of Nigerian healthcare professionals, patients and scientists.Ethics and disseminationThe results will be disseminated through peer-reviewed publications. By highlighting the key gaps in the literature, this review can provide direction for future research and clinical guidelines in Nigeria (and other low-income and middle-income countries), where BC is more prevalent due to local risk factors and healthcare settings.

Wired and Hired: Employment Effects of Subsidized Broadband Internet for Low-Income Americans

2021 ◽  
Vol 13 (3) ◽  
pp. 447-482
Author(s):  
George W. Zuo
Keyword(s):  
Low Income ◽  
Labor Market Outcomes ◽  
Market Outcomes ◽  
Broadband Internet ◽  
Present Evidence ◽  
Employment Effects ◽  
Local Program ◽  
Low Income Families ◽  
Employment Rates ◽  
The Relationship

I present evidence on the relationship between broadband pricing and labor market outcomes for low-income individuals. Specifically, I estimate the effects of a Comcast service providing discounted broadband to qualifying low-income families. I use a triple differences strategy exploiting geographic variation in Comcast coverage, individual variation in eligibility, and temporal variation pre- and postlaunch. Local program availability increased employment rates and earnings of eligible individuals, driven by greater labor force participation and decreased probability of unemployment. Internet use increased substantially where the program was available. (JEL I32, J22, J31, L82, L86)

Measurement of Individual Clinical Productivity in an Academic Anesthesiology Department

2000 ◽  
Vol 93 (6) ◽  
pp. 1509-1516 ◽  
Author(s):  
Amr E. Abouleish ◽  
Mark H. Zornow ◽  
Ronald S. Levy ◽  
James Abate ◽  
Donald S. Prough
Keyword(s):  
Medical Center ◽  
Clinical Care ◽  
Obstetric Anesthesia ◽  
Fiscal Year ◽  
Full Time ◽  
Full Time Equivalent ◽  
High Productivity ◽  
Academic Settings ◽  
Individual Productivity ◽  
American Society

Background The ability to measure productivity, work performed, or contributions toward the clinical mission has become an important issue facing anesthesiology departments in private practice and academic settings. Unfortunately, the practice and billing of anesthesia services makes it difficult to quantify individual productivity. This study examines the following methods of measuring individual productivity: normalized clinical days per year (nCD/yr); time units per operating-room day worked (TU/OR day); normalized time units per year (nTU/yr); total American Society of Anesthesiologists (ASA) units per OR day (tASA/OR day); and normalized total ASA units per year (ntASA/yr). Methods Billing and scheduling data for clinical activities of faculty members of an anesthesiology department at a university medical center were collected and analyzed for the 1998 fiscal year. All clinical sites and all clinical faculty anesthesiologists were included unless they spent less than 20% of their time during the fiscal year providing clinical care, i.e., less than 0.2 clinical full-time equivalent. Outliers, defined as faculty who had productivity greater or less than 1 SD from the mean, were examined in detail. Results Mean and median values were reported for each measurement, and different groups of outliers were identified. nCD/yr identified faculty who worked more than their clinical full-time equivalent would have predicted. TU/OR day and tASA/OR day identified apparently low-productivity faculty as those who worked a large portion of their time in obstetric anesthesia or an ambulatory surgicenter. tASA/OR day identified specialty anesthesiologists as apparently high-productivity faculty. nTU/yr and ntASA/yr were products of the per-OR day measurement and nCD/yr. Conclusion Each of the measurements studied values certain types of productivity more than others. By defining what type of service is most important to reward, the most appropriate measure or combination of measures of productivity can be chosen. In the authors' department, nCD/yr is the most useful measure of individual productivity because it measures an individual anesthesiologist's contribution to daily staffing, includes all clinical sites, is independent of nonanesthesia factors, and is easy to collect and determine.

scholarly journals Promoting educational opportunity and achievement through 1:1 iPads

2017 ◽  
Vol 34 (5) ◽  
pp. 409-427 ◽  
Author(s):  
Gayle Y. Thieman ◽  
Tatiana Cevallos
Keyword(s):  
Student Achievement ◽  
Survey Data ◽  
Low Income ◽  
Technology Use ◽  
Administrative Support ◽  
Educational Opportunity ◽  
White Female ◽  
Technology Access ◽  
Content Type ◽  
Instructional Use

Purpose The purpose of this paper is to expand the growing body of research on the educational impact of 1:1 mobile devices, investigating the iPad’s potential to reduce the disparity of access to high-quality instructional technology and achievement for low income, racially, and linguistically diverse students. Design/methodology/approach This three-year, mixed-method study investigated the degree to which a 1:1 iPad initiative reduced the disparity of technology access and instructional use and improved student learning and attendance. The research design included survey data on student technology skills, experiences and use and teacher focus groups to confirm and contextualize the survey data. Findings Across all three years, ninth graders and students who were white, female, eligible for free/reduced lunch and those with stable enrollment were more likely to have an individual iPad (THP). Having a THP was associated with greater satisfaction, ease and frequency of technology use, higher attendance and GPA. Research limitations/implications Inequitable distribution, inconsistent administrative support, and uneven faculty support for iPads limit generalizability. Practical implications This research identifies barriers to successful technology integration and impact on student achievement including inequitable access, inconsistent administrative and teacher support, and limited professional development. Originality/value This research focuses on an issue of digital equity that has not yet been studied in depth with 1:1 iPads and investigates students’ technology access, experiences and use to support student achievement in a high poverty, highly diverse high school.

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